California's Proposed 2009 Permanent Disability Rating Schedule - Is Your Head Spinning Yet?

Sun, 11 May 2008 12:32:03 GMT

Posted by Robert G. Rassp, Esq.

DWC Unveils Proposed Rules

On May 9, 2008, the Division of Workers’ Compensation announced the long awaited revision of the permanent disability rating schedule (PDRS) which changes the arrangement of FEC adjustments for each injured part of body and also increases each FEC multiplier as well.

Effective Dates for 2009 PDRS

The proposed 2009 PDRS, mandated by Cal. Lab. Code &

What in the Heck is an Expert Content Provider?

Karen C Yotis — Sat, 10 May 2008 00:10:11 GMT

Have you seen the lead story in our Movers & Shakers section about Meckler Bulger & Tilson being selected as the first LexisNexis Expert Content Provider for Insurance? Sounds impressive, doesn’t it? But what the heck does it mean?

All About EAMS

Colleen Casey — Fri, 09 May 2008 13:29:29 GMT

As the DWC starts its transition to a "less paper" world, the workers' comp community will need to have ready access to everything related to EAMS (Electronic Adjudication Management System.) How will conferences and trials be conducted? What type of equipment do I need to use EAMS? How will privacy concerns be addressed?

I. Answers to Frequently Asked Questions

All of these questions and more can be found on the DWC website by clicking on: http://www.dir.ca.gov/dwc

Recent Insurance Fraud Decisions

Barry Zalma — Fri, 02 May 2008 11:24:04 GMT

The attempts to prevent insurance fraud are not entirely useless. As I report in this month's issue of Zalma's Insurance Fraud Letter, the following were convicted of variations of the crime of insurance fraud:

Convictions

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Conditional Endorsement, Underlying Allegations Thwart Contribution Right

Vivi Gorman — Thu, 01 May 2008 11:51:57 GMT

The Second District California Court of Appeal this week prevented a general contractor’s insurer from recouping defense costs relating to an underlying construction defects lawsuit from an insurer of a drywall subcontractor under a theory of equitable contribution where the underlying complaint makes no allegations concerning drywall installation or defects.

In Monticello Insurance Co. v. Essex Insurance Co. (April 28, 2008), the additional insured endorsement at issue i

Vexatious Litigation

Barry Zalma — Wed, 30 Apr 2008 11:39:59 GMT

It should be axiomatic that almost every lawsuit is defended by one or more insurance companies and most civil judgments are paid by insurance. Vexatious litigation skews actuarial tables and increases the cost of insurance to everyone.

A case in point is Molski v. Evergreen Dynasty Corp., No. 05-56452 (9th Cir

Easing into EAMS

Colleen Casey — Mon, 28 Apr 2008 10:17:41 GMT

I. Overview of the System

DWC is entering the digital age. The Electronic Adjudication Management System (EAMS) will allow us to switch from paper to paperless in a gradual three-step process.

Phase 1 - Creation of the EAMS system
Silent PPO Webinar: Recording and Materials Now Available

Robin E Kobayashi — Tue, 22 Apr 2008 12:53:38 GMT

Available now for a limited time! The recording and power point presentation for the LexisNexis webinar The Silent PPO Dilemna: California’s Medical Providers Harmed by Stealth Contracts are now posted on this site.

To listen to the audio recording and to access the power point presentation of the Silent PPO webinar, go to
Richard L. Fenton — Thu, 17 Apr 2008 12:02:48 GMT

The State of Louisiana has made and is making so-called “Road Home” grants to Louisiana homeowners rebuilding homes damaged or destroyed by Hurricanes Katrina and Rita. The homeowners assign the right to all insurance benefits that may be due them, up to the amount of the grant. Louisiana contends that insurers have been denying benefits actually due, thereby reducing Louisiana’s recoveries. It filed a massive class action against more that 200 insurance car

Insurance Bad Faith - Minnesota Takes a Step in the Right Direction

Barry Zalma — Wed, 16 Apr 2008 11:57:02 GMT
In a move that will stick in the craw of the plaintiffs'' bar and stop most claims of bad-faith, improve the availability and price of insurance in Minnesota, and take the profit motive out of insurance claims, Minnesota lawmakers approved a bill limiting bad faith claims against insurers. The new statute passed on April 14, 2008: (1) Limits bad faith causes of action to first party claimants only, (2) requires a reasonable basis for denying a claim and (3) allows insurers to conduct fraud or fi

Insurance Fraud -- Man Bites Dog

Barry Zalma — Tue, 15 Apr 2008 16:26:51 GMT

The 1994 Northridge, California earthquake that caused billions of dollars in damages across Southern California also drew unscrupulous lawyers and public adjusters seeking fast money. Investigation was limited and because of the catastrophe many unnecessary and spurious suits were filed. Insurance fraud was rampant and insurers paid rather than fight. In addition insurers denied claims they should not have denied.

Their errors caused the state of California

Insurance Fraud Recent Developments

Barry Zalma — Tue, 15 Apr 2008 12:10:08 GMT

Although insurance fraud is the least prosecuted of major felonies, I try to give credit to those few agencies who actually arrest, try and convict insurance fraud criminals. Here are some I collected last month. As you read note the wide disparity in penalties imposed by the various jurisdictions.

Medicaid Fraud Defeated CVS Caremark Corp. agreed in March 2008 to pay almost $37 million to nearly two dozen states and the federal government to settle

Heads I Win, Tails You Lose - A Proposal to Defeat Insurance Fraud

Barry Zalma — Mon, 14 Apr 2008 13:40:34 GMT

Insurance fraud is not a local problem. It is a depletion of the wealth of the entire country. Insurance fraud is recognized to be a $100 Billion yearly crime in which the victims of the crime are insurers who are less than loved by the public. If properly prepared, however, the insurer victim can avoid liability to those who attempt to profit from an insurance policy by fraudulent conduct.

The majority of fraudulent insurance claims are made by people with legitimate claims covered

Partial Summary Judgment on in Bad Faith Case Arising Out of Hurricane Katrina

Robert M. Lopatin — Wed, 09 Apr 2008 10:09:56 GMT

Judge Brian E. Sandoval of the U.S. District Court in Nevada awarded a partial summary judgment to a leading national gaming operator. Pinnacle Entertainment, Inc., in an insurance coverage case arising out of Hurricane Katrina.

The c

Sonnenschein Nath & Rosenthal LLP on Sher v. Lafayette Ins. Co.: Lousiana Supreme Court Enforces Flood Exclusion in Flooding of New Orleans

William T. Barker — Wed, 09 Apr 2008 08:59:49 GMT

The Louisiana Supreme Court has unanimously enforced the flood exclusion for Hurricane Katrina losses in New Orleans. Sher had a five-unit apartment building that suffered some wind damage to the upper stories and had flood waters reach a level of four feet deep in the first level. The trial court held the flood exclusion ambiguous and ineffective. A jury made separate awards for damage to the upper stories and damage to the first level and a lost rents award for both parts o

Sonnenschein Nath & Rosenthal LLP on Broussard v. State Farm: Fifth Circuit Clarifies Burdens of Proof on Wind v. Water

William T. Barker — Tue, 08 Apr 2008 09:05:10 GMT

On April 7, 2008, the Fifth Circuit reversed a judgment for actual and punitive damages against State Farm in a Mississippi bad faith case arising out of Hurricane Katrina. Storm surge had left the Broussards’ home totally destroyed, leaving only the foundation slab. Their policy had “named peril” coverage for wind damage to their personal property and “open peril” coverage for da

Trademark Infringement Claim Might Trigger Coverage Despite Exclusion

Jeffrey L. Kingsley — Mon, 07 Apr 2008 09:17:37 GMT
Policyholder notified his insurer regarding a trademark infringement lawsuit over his band name, "The Doors", and requested coverage under his commercial general policies. Insurer denied coverage on the basis that such a claim was excluded from coverage under the "field of entertainment" exclusion. The Ninth Circuit concluded that there is an argument that the complaint asserts a separate breach of contract action that, at minimum, raises at least the potential for coverage u

Calling All Insurance Geeks...

Vivi Gorman — Thu, 27 Mar 2008 16:12:03 GMT

If you fancy yourself an insurance geek extraordinaire (or even apprentice), it’s the kind of thing that’ll make you say “saweet” out loud. Now you can get asbestos insurance case news of 2007 all together in your favorite place: this link right here. Mea

A Better Approach to Flood Insurance After Katrina

Jeffrey W. Stempel — Mon, 24 Mar 2008 14:37:28 GMT

Hurricane Katrina engendered an avalanche of coverage litigation (calling it a "flood" would be too badly sick a pun). Countless hours of judicial and attorney time (and corresponding financial and social cost) has been expended, primarily over the degree to which property destruction resulted from windstorm versus water damage, with substantial disputing over the question of whether the broadly worded flood exclusions foun

Reforming the Insurance Industry to Better Compensate Victims of Catastrophe

Robert M. Lopatin — Mon, 24 Mar 2008 11:58:33 GMT

A plenary session at the ICLC Annual Meeting on February 28 was entitled “Confronting Catastrophe: Pandemics, Hurricanes, Terrorists – Oh My!” The program noted that “The extreme ruin caused by Hurricane Katrina would pale in comparison to a nationwide calamity, such as a flu pandemic. This audience interactive session will leverage the advice of experts, including professionals who endured Hurricane Katrina and its aftermath, to explore the role of the legal prof

March is "Hurricane Katrina and Catastrophic Loss Month" (more or less) on the Insurance Law Center

Karen C Yotis — Sat, 22 Mar 2008 00:18:41 GMT

We’re going to try something a little different in an effort to enrich your experience when you visit the insurance law center. With the assistance of that eclectic group known as the Insurance Law Center Advisory Board (two coverage attorneys, a couple of insurance law professors and a former insurance commissioner) we’ve formulated a list of issues—hot topics if you will—that we think will pique your interes

Comic Relief From Examinations Under Oath

Jennifer Hans — Wed, 19 Mar 2008 11:24:28 GMT

I have to admit, I got such a kick out of John J. Pappas "From Beautiful Brazilians to Bear-Catchers" commentary that was featured in yesterday's issue of Insurance Bad Faith.

I am a journalist, not a lawyer; so I just write about litigation, and unfortunately miss out on experiencing the day-to-day gems that Pappas gets to witness first hand, such as his story of a burly father with bushy eyebrows (who claimed to once being a Greek Ambassador

AIG To Pay $9.1M To Pennsylvania To Settle Bid Rigging Charges

Shawn Rice — Tue, 18 Mar 2008 11:52:46 GMT

American International Group Inc. (AIG) agreed yesterday to pay Pennsylvania $9.1 million to settle allegations regarding bid-rigging and client steering. The agreement settles Pennsylvania Insurance Commissioner, Joel Ario's investigation into AIG's financial reporting concerning its alleged reinsurance deal.

In February, a former AIG executive and four former Gen Re executives were found guilty for their part in a transaction related to the financial misreporting that is the b

Second Circuit Dismisses Health Insurance Plan Participant's Claims Under ERISA and WHCRA for Failure to Fully Reimburse Medical Expenses

Jeffrey L. Kingsley — Fri, 14 Mar 2008 17:31:19 GMT
Recently, the Second Circuit in Krauss v. Oxford Health Plans, Inc. et al., affirmed the lower court's dismissal of allegations that the health insurance plan violated Employee Retirement Income Security Act (ERISA) and Women's Health and Cancer Rights Act (WHCRA) by declining to fully reimburse medical

ICLC Panel Discussion: To Renew or Not to Renew

Robert M. Lopatin — Thu, 13 Mar 2008 12:19:21 GMT

The ICLC annual meeting in Tucson included a session on directors’ and officers’ insurance policies on February 28, entitled, “To Renew or Not to Renew? The $64,000,000 Question.” A panel consisting of Mary Craig Calkins of Howrey LLP; Deidre Finn of Navigators Pro, Carla Owens of the Chubb Insurance Company, and executive insurance consultant Kevin Ishizu focused on a hypothetical renewal of a

The Way I Drink It

Tom Hagy — Tue, 11 Mar 2008 19:05:26 GMT

So I am having a cup of coffee at Starbucks and in a dubious moment of consciousness (I am not a morning person; I am not even an afternoon person) I noticed a feature on the cup that’s probably been around for 10 years: Starbucks’ “The Way I See It” series of quotes from famous people. My coffee mates, one live, one virtual (don’t ask) had quotes from Newt Gingrich and Madeline Albright. I had this one from Presumed Innocent author Scott T

Is There A Cause of Action For A Participant Under §502(a)(2) of ERISA? The Supreme Court Says Yes!

Jeffrey L. Kingsley — Tue, 11 Mar 2008 13:44:49 GMT
In LaRue v. DeWolff, Boberg & Assoc. 552 U.S. ___ (2008), the Supreme Court unanimously ruled that §502(a)(2) of the Employee Retirement Income Security Act (ERISA) allows a participant to recover damages from his employer for any fiduciary breaches that impair the value of a plan's assets in an individual account. The Fourth Circuit previously held that a participant did not have a separate right under that section of ERISA. For more information regarding this case, contact Jeff Kingsl

Governor Spitzer Fallout: Workers' Comp Reforms in the Balance?

Robin E Kobayashi — Mon, 10 Mar 2008 19:06:45 GMT

Earlier today The New York Times broke the story on its webpage that Governor Eliot Spitzer has been linked with a prostitution ring. Spitzer, known as a crusader against corruption, signed into law major workers' comp reforms in 2007.

If Spitzer resigns, Lieutenant Governor David A. Paterson will become Governor. Paterson is said to be a leading contender to fill Hillary Rodham Clinton's Senate seat if she becomes President.

It remains to be seen what will happen to

People: Throw Off Your Shackles and Blog!

David P. Rossmiller — Mon, 10 Mar 2008 13:15:43 GMT

As someone who has built a successful law blog and who has been blogging daily for more than two years, I’ve been asked to write a series of posts talking about how to blog, what to do and what not to do. “How to” blog is always a tricky, touchy subject, one that sounds dangerously close to impinging on the thing that is most beloved among bloggers, their autonomy and sense of freedom. The internet is the new Final F

Texas Public Policy Does Not Preclude Insurance Coverage for Exemplary Damages Due to Employer's Gross Negligence Under Workers' Compensation and Employer's Liability Policy

Jeffrey L. Kingsley — Fri, 07 Mar 2008 16:30:33 GMT
After analyzing the Texas Workers' Compensation and Employer's Liability Statutory scheme, the Supreme Court of Texas in Fairfield Ins. Co. v. Stephens Martin Paving, LP(currently unpublished) held that the state legislature had the authority to authorize the Texas Department of Insurance to create a policy that provides insurance coverage for exemplary damages in workers' compensation cases. In answering the certified questions poised by the United States Fifth Circuit, the Court ruled that pub

Oregon High Court Rules 4-To-1 Is Maximum Punitive Award Allowed Against Insurer

Jennifer Hans — Fri, 07 Mar 2008 13:49:17 GMT

The Oregon Supreme Court yesterday affirmed that a $20 million punitive damages verdict against Farmers Insurance Company of Oregon is excessive but found that the case "fully justifies the highest permisible award, viz., an award tht is four times the amount of plaintiff's actual and potential harm."

The high court modified the Oregon Court of Appeals' opinion, which found for a three to one ratio.

ABA Section of Labor and Employment Law; Workers' Compensation Committee, Midwinter Seminar and Conference

Robin E Kobayashi — Thu, 06 Mar 2008 17:39:58 GMT

Lex K. Larson, the author of Larson's Workers' Compensation Law (Matthew Bender), was a member of this morning's "Joint WC/OSHA Panel: How Work Injuries and Fatalities Involving OSHA Citations Have the Potential to Turn into Civil Liability Tort Claims Against Employers Under Various State Labor Acts."

Larson noted that, traditionally, intentional acts by an employer that inflict injury on an employee are not barred by the exclusive remedy provisions of workers' com

Like Buttah . . . Just Maybe More Hazardous

Vivi Gorman — Thu, 06 Mar 2008 17:10:46 GMT

At least one popcorn maker vowed to remove the chemical diacetyl from its butter-flavored products after Occupational and Safety Health Administration initiated an investigation into the safety protocols at factories where the flavoring agent is used. Diacetyl, an artificial agent that creates the buttery odor and flavor in microwave popcorn and other products, has been linked to respiratory disease in workers at microwave popco

Peeling the Onion: Layers of New D&O Coverage Issues

Serena Wellen — Mon, 03 Mar 2008 07:59:03 GMT

A February 29 session at the meeting in Tucson celebrating the 20^th Anniversary of the Insurance Coverage Litigation Committee was entitled, “Peeling the Onion: Layers of New D&O Coverage Issues.” The panel at this session discussed the interplay and tension between the various layers of coverage in the face of changes in the world of D&O liability, including increases in derivative actions, the size of securities litigation settlements, SEC investigatio

LexisNexis Insurance: Insurance

California's Proposed 2009 Permanent Disability Rating Schedule - Is Your Head Spinning Yet?

What in the Heck is an Expert Content Provider?

All About EAMS

Recent Insurance Fraud Decisions

Conditional Endorsement, Underlying Allegations Thwart Contribution Right

Vexatious Litigation

Easing into EAMS

Silent PPO Webinar: Recording and Materials Now Available

Insurance Bad Faith - Minnesota Takes a Step in the Right Direction

Insurance Fraud -- Man Bites Dog

Insurance Fraud Recent Developments

Heads I Win, Tails You Lose - A Proposal to Defeat Insurance Fraud

Partial Summary Judgment on in Bad Faith Case Arising Out of Hurricane Katrina

Sonnenschein Nath & Rosenthal LLP on Sher v. Lafayette Ins. Co.: Lousiana Supreme Court Enforces Flood Exclusion in Flooding of New Orleans

Sonnenschein Nath & Rosenthal LLP on Broussard v. State Farm: Fifth Circuit Clarifies Burdens of Proof on Wind v. Water

Trademark Infringement Claim Might Trigger Coverage Despite Exclusion

Calling All Insurance Geeks...

A Better Approach to Flood Insurance After Katrina

Reforming the Insurance Industry to Better Compensate Victims of Catastrophe

March is "Hurricane Katrina and Catastrophic Loss Month" (more or less) on the Insurance Law Center

Comic Relief From Examinations Under Oath

AIG To Pay $9.1M To Pennsylvania To Settle Bid Rigging Charges

Second Circuit Dismisses Health Insurance Plan Participant's Claims Under ERISA and WHCRA for Failure to Fully Reimburse Medical Expenses

ICLC Panel Discussion: To Renew or Not to Renew

The Way I Drink It

Is There A Cause of Action For A Participant Under §502(a)(2) of ERISA? The Supreme Court Says Yes!

Governor Spitzer Fallout: Workers' Comp Reforms in the Balance?

People: Throw Off Your Shackles and Blog!

Texas Public Policy Does Not Preclude Insurance Coverage for Exemplary Damages Due to Employer's Gross Negligence Under Workers' Compensation and Employer's Liability Policy

Oregon High Court Rules 4-To-1 Is Maximum Punitive Award Allowed Against Insurer

ABA Section of Labor and Employment Law; Workers' Compensation Committee, Midwinter Seminar and Conference

Like Buttah . . . Just Maybe More Hazardous

Peeling the Onion: Layers of New D&O Coverage Issues